Retropharyngeal lipostructure in the treatment of velopharyngeal insufficiency: A prospective study and update

Abstract Introduction Retropharyngeal lipostructure is a recent procedure in velopharyngeal insufficiency (VPI), offering an effective alternative to heavier surgery. Objectives To update and assess retropharyngeal lipostructure as a treatment for VPI in the University Hospital Center of Rouen (France). Type of study Single-center prospective study, from May 2012 to May 2014. Patients and methods Six patients (4 girls, 2 boys) presenting with VPI were treated by retropharyngeal lipostructure. Age at surgery ranged between 6 and 12 years. Four of the patients bore a 22q11 microdeletion. Treatment was indicated in case of Borel-Maisonny type 2b ( n  = 2) or 2 m ( n  = 4) despite well-conducted speech therapy and of ≥ 50% velopharyngeal sphincter closure on nasal endoscopy. Patients were assessed preoperatively and at 3 months, by a multidisciplinary team. Borel-Maisonny type was assessed by a speech therapist. Nasality was measured on assisted vocal evaluation (EVA ® ). Sphincter closure was assessed on dynamic MRI. Results Between 6 and 8 cm 3 autologous fat was injected. At 3 months, 4 children showed 1-grade improvement in Borel-Maisonny type. Nasality decreased systematically, from a mean 14.5% preoperatively to 10.5% postoperatively. MRI showed improvement in all cases, with complete closure in occlusive vowels in 3 children. Conclusion EVA ® and MRI provide precise objective assessment of VPI. Retropharyngeal lipostructure is a simple, relatively non-invasive, reproducible technique, providing good results in VPI.